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Table 6 Statements related to the micro-, meso- or macro-level

From: Implementing evidence-based medicine in general practice: a focus group based study

Reference Number

Statement

MICRO 4:134.2*

Look, it is like you just said: if people come to me and say:" I want that blood analyses!", I will do it...

6:30.2

Information that is brought in by patients from the internet is not evidence-based in most of the cases. It conflicts with what we know and are willing to provide. It is a tough discussion... (A:8,9)*

1:53.2

...People who take statines for several years for example... at one point in time you have to say:" quit using them because the reason I prescribed it for you, three years ago, it does not have any value today (B: laughing). I know you took it three years, but it is okay, quit using them immediately..."

4:148.5

But take the discussion about anti-hypertensions for instance. I expect from a specialist that he knows what he is talking about, it is his job. But sometimes they are just promoting medical products, they advertise... and I think he will have had his pleasant trip organised by a company... that feeling is hard to deal with. I do not feel like they are acting evidence-based.

1:65.6

The last month I got two patients back... look, your patient does not fulfil our criteria and so he does not have to come. And I think: "Is that the kind of medicine I will be forced to do? That person comes with his complaints, whether he is fulfilling my criteria or not. But that will be the future task of the GP: helping the people who do not fit the criteria of the specialists.

1:56.1

Sometimes I have the feeling that those people who are not connected to a university or an academic hospital ... the ones that are more modal... when they take the word, when they take over, it is easier. Late adapters get convinced and start moving.

4:180.3

A GP who works alone needs a contact to people who can guide him in a certain way, because there is to less time to figure it out yourself. That step can be made very easily, because you know who can be contacted and so on...

4:181.2

Some time ago one was talking about independent educators from government for outreach visits. Now that would be interesting, for instance to visit each GP for half an hour – once a year – like commercial representatives. They can explain where the good sites are, how they are used, show all options. And then after half a year they can come back to see how it went, did you use it? And now let's see how you can use it during your consultations...That would be interesting...

1:126.4

If one would like to know something about a certain topic, one interviews professor bla bla bla. He will know what it is all about... instead of organising a social debate, in which complexity of EBM can be explained to the public. Government can play an important role in that.

MESO 6:99.9

There's too much fragmentation: evidence-based journals, scientific institutions, organisations for EBM...all trying to promote evidence-based acting. It would be a good thing for those initiatives to melt together.

1:152.5

The booming business in the US... right now they are setting up commercial structures to make products of other companies evidence-based. That's business... not developing drugs, but developing evidence and set up large studies... sell them as evidence, to impress the rest of the world.

5:73.3

I held an archive of all medical information for one month for a talk a prepared for a governmental organisation. I had such a big amount of information! It is incredible how much we are influenced by commercial institutions and it is in no way comparable with the scarce information we get from independent sources. I think government must take a more active role in providing that kind of information.

1:101.4

There is a culture rising where patients are defined as consumers in a health care system. But often messages of consumer organisations are counterproductive, because they are not methodologically sound.

MACRO 1:188.6

I had a patient in my office lately that went to a specialist who said:" I have to talk to you for five more minutes because I need to gain an average of 10 minutes for a consultation (B: laughing)*. A rule from management.

4:102.2

The system is counterproductive for EBM. Some gynaecologists and GPs make a cervical smear every half year. If I tell that in the Netherlands they will have a good laugh, because they only do it once in three years. In Flanders women become 'smeared' far to often, just because it is easy money.

4:132.6

And I think government may be firm about that. If they say one cervical smear each three years, it means that there is only one pay-back to the patient. If the doctor talks you into more than one, ... sorry, you have to pay for it yourself (I:7,5)

1:212.5

It is the good care for the patient that should guide judgements about clinical practice and should be the most important parameter,... the degree of practicing evidence-based medicine can not be the sole norm (A:all)

1:98.2

... if you hear things like allowing drug commercials on television. Well, that's like cleaning the floor while someone is painting the ceiling, because they heard on the commercials how good this drug is... and you have to explain, based on evidence, that it is not... and tell your story over and over because they all have seen it on television.

6:27.8

Yes, but all is presented so over-simplified...it makes consultations more difficult. In the past we were God himself and said: here take clamoxyle and go home. Our scheme was simple back then. On this side science is sitting and on the other side the dependent patient.

1:149.3

Economic thinking would be using the means we have as efficient as possible, based on transparent choices. We are not there yet and that's a reason why doctors should sit around the policy table too, to negotiate. We have to prevent letting public servants and insurance companies take decisions about health care on their own, because that indeed would be dangerous.

5:56.3

..."The publishers feel that it will be helpful for clinicians to know whether their uncertainty sustains from the gap in the evidence rather than the gap in their own knowledge." So for the most questions there will be no clear answer, not because you do not know it but because evidence simply does not exist. And than it is up to you to take decisions.

6:11.8

I often ask myself... that EBM process is so slow-moving. By the time everyone has picked up the new evidence there probably will be a second movement that will reject those findings or will look at them from a different point of view.

 

*first nr. = focus group/second nr. = citation/third nr. = respondent – A = agreement followed by respondent – B = behaviour (software programme ATLAS-ti)